Provider Demographics
NPI:1750561411
Name:D'AGOSTINO, ANDREW RICHARD III
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RICHARD
Last Name:D'AGOSTINO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-5406
Mailing Address - Country:US
Mailing Address - Phone:781-935-1470
Mailing Address - Fax:
Practice Address - Street 1:1 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-5406
Practice Address - Country:US
Practice Address - Phone:781-935-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health